<!DOCTYPE html>
<html>
<head>
    <meta charset="utf-8">
    <title>Layui</title>
    <meta name="renderer" content="webkit">
    <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
    <link rel="stylesheet" href="/static/layui/css/layui.css"  media="all">
    <#include "/common/base.ftl"/>
    <script src="/static/layui/layui.js" charset="utf-8"></script>
    <script src="/static/layui/config.js"></script>
    <style>
        table, tr, td{
            border: 0px !important;
        }
        td{
            width: 33%;
        }
    </style>
</head>
<body>

<div class="wrapper wrapper-content">
    <div class="col-sm-12" id="app_form">

        <div class="row">
            <div class="col-sm-12">
                <fieldset>
                    <legend style="font-size: 15px">申请信息</legend>
                    <table class="table table-hover no-margins no-borders">
                        <tr>
                            <td>申请编号：<label id="uuid"></label></td>
                            <td >获取方式：<label id="transType"></label></td>
                            <td >病历类型：<label id="recType"></label></td>
                        </tr>
                        <tr>
                            <td>医院简称：<label id="hospName"></label></td>
                            <td >住院号：<label id="cureNo"></label></td>
                            <td >出院状态：<label id="cureStatus"></label></td>
                        </tr>
                        <tr>
                            <td>备注：<label id="rmk"></label></td>
                            <td >打印通途：<label id="printPurp"></label></td>
                            <td >打印份数：<label id="printCount"></label></td>
                        </tr>
                        <tr>
                            <td>是否有病理报告：<label id="caseReport"></label></td>
                            <td >支付状态：<label id="payStatus"></label></td>
                            <td ></td>
                        </tr>
                        <tr>
                            <td>单份病历金额：<label id="singlePrice"></label> 元</td>
                            <td >邮寄金额：<label id="transPrice"></label> 元</td>
                            <td >总金额：<label id="payPrice"></label> 元</td>
                        </tr>
                    </table>

                    <legend style="margin-top: 20px;font-size: 15px">地址信息</legend>
                    <table class="table table-hover no-margins no-borders">
                        <tr>
                            <td>省：<label id="recInfo_pcaInfo_pname"></label></td>
                            <td >市：<label id="recInfo_pcaInfo_cname"></label></td>
                            <td >区：<label id="recInfo_pcaInfo_aname"></label></td>
                        </tr>
                        <tr>
                            <td colspan="3">详细地址：<label id="recInfo_recvAddr"></label></td>
                        </tr>
                        <tr>
                            <td>收件人：<label id="recInfo_recvName"></label></td>
                            <td >联系电话：<label id="recInfo_recvMobile"></label></td>
                            <td ></td>
                        </tr>
                    </table>
                </fieldset>
            </div>
        </div>
    </div>
</div>
</body>
</html>